Thrombolysis before Thrombectomy in Stroke — A Bridge Not Fallen

Leung, Thomas W. M.D.

¹Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
²Kwok Tak Seng Center for Stroke Research and Intervention, Chinese University of Hong Kong, Hong Kong

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New England Journal of Medicine 393(2):p 189-191, July 10, 2025. | DOI: 10.1056/NEJMe2506729

Endovascular thrombectomy has been shown to be safe and effective in selected patients with acute ischemic stroke due to large-vessel occlusion (LVO) up to 24 hours after symptom onset.¹ In pivotal randomized, controlled trials, endovascular thrombectomy was studied as an adjunct to standard therapy with intravenous thrombolysis for LVO strokes. Current guidelines recommend bridging therapy with intravenous thrombolysis before endovascular thrombectomy in eligible patients presenting within the treatment window (4.5 hours after symptom onset).² However, intravenous thrombolysis alone has a relatively small treatment effect for LVO strokes, which has led to the question of whether timely recanalization with endovascular thrombectomy …